August 24, 2017Scientific ReportsOpen Access

The Diagnostic Value of Global Longitudinal Strain (GLS) on Myocardial Infarction Size by Echocardiography: A Systematic Review and Meta-analysis

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Why the study?

Does global longitudinal strain (GLS) measured by echocardiography accurately determine myocardial infarction size compared to CMR in patients with a first MI?

Structured PICO

Does global longitudinal strain (GLS) measured by echocardiography accurately determine myocardial infarction size compared to CMR in patients with a first MI?

Population

11 trials pooling 765 patients who had experienced their first myocardial infarction.

Intervention

Global longitudinal strain (GLS) measurement using two-dimensional (2D) and three-dimensional (3D) speckle tracking echocardiography (STE).

Comparator

Late gadolinium enhancement (LGE) by cardiovascular magnetic resonance (CMR) as the reference standard.

Outcome

Correlation between GLS and LGE percentage, and diagnostic accuracy (sensitivity, specificity, PLR, NLR, DOR, AUC) to differentiate a myocardial infarction size >12%.surrogate

2D global longitudinal strain by echocardiography is a valid diagnostic index that correlates well with CMR for assessing myocardial infarction size in patients with a first MI.

Limitations

Insufficient consolidated STE studies to determine the value of 3D STE

Implication

Supports 2D GLS as a valid noninvasive alternative to CMR for MI size in first-MI patients; confirms strong pooled diagnostic performance.

Abstract

A systematic review and meta-analysis of prospective randomized studies were performed to evaluate the diagnostic value of measuring global longitudinal strain (GLS) using speckle tracking echocardiography (STE) in determining myocardial infarction (MI) size, which is usually measured based on late gadolinium enhancement (LGE) by cardiovascular magnetic resonance (CMR). Eleven trials with a total of 765 patients were included. The pooled correlation was 0.70 (95% CI: 0.64, 0.74) between two-dimensional (2D) GLS and the LGE percentage, and it was 0.55 (95% CI: 0.19, 0.78) for three-dimensional (3D) GLS. Pooled diagnostic estimates for 2D GLS to differentiate an MI size >12% were as follows: sensitivity, 0.77 (95% CI: 0.61, 0.90); specificity, 0.86 (95% CI: 0.68, 0.96); positive likelihood ratio (PLR), 8.13 (95% CI: 1.90, 26.61); negative likelihood ratio (NLR), 0.28 (95% CI: 0.10, 0.54); and diagnostic odds ratio (DOR), 39.87 (95% CI: 4.12, 172.83). The estimated area under the curve (AUC) of the summary receiver operating characteristic (SROC) curve was 0.702. The 2D STE results positively correlated with the infarction size quantified by CMR for patients who had experienced their first MI. This approach can serve as a good diagnostic index for assessing infarction area. However, more consolidated STE studies are still needed to determine the value of 3D STE.